Parashar Bhupesh, Port Jeffery, Arora Shruthi, Christos Paul, Trichter Samuel, Nori Dattatreyudu, Wernicke A Gabriella
Department of Radiation Oncology, Weill Cornell Medical Center, New York.
Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York.
Brachytherapy. 2015 Sep-Oct;14(5):648-54. doi: 10.1016/j.brachy.2015.04.001. Epub 2015 May 19.
The purpose of the study was to evaluate the outcomes for wedge resection (WR), WR plus brachytherapy (WRB), or stereotactic body radiation therapy (SBRT) for early stage non-small lung cancer.
Retrospectively collected data of patients treated with WR, WRB, or SBRT (1993-2012). Cesium-131 (Cs131) used in WRB group in patients with close or positive margins based on surgical assessment. Kaplan-Meier survival analysis, log-rank test used to compare disease-free survival/overall survival between different groups. Multivariable analysis, using Cox proportional hazards regression analysis, was performed to evaluate the independent effect of age, gender, and treatment procedure on disease-free survival.
A total of 272 patients were included in the study (123 WR, 52 WR+Cs-131, 97 SBRT). Cs-131 was used with WRs that the surgeons deemed high risk. Local control (LC) was similar in the three groups and was achieved in 92.2% for WR group vs. 96.2% for WR+Cs-131 and 95.5% for SBRT (p = 0.60). On multivariate analysis, although females showed a higher LC, neither LC nor distant metastasis were associated with age or gender (p = 0.65 and p = 0.41, respectively). Five-year overall survival was 100% in the WR+B group, 97.7% in the WR group, and 89.6% in the SBRT group (p = 0.02). Toxicity was similar in the three groups.
WR, WR+ Cs-131, or SBRT are all excellent treatment options for patients with early stage non-small cell lung cancer that are not candidates for lobectomy. For high risk WRs, we favor use of Cesim-131 brachytherapy. Until a prospective randomized comparative study is done to evaluate the best treatment approach for early stage NSCLC, treatment selection should be based on a multidisciplinary team approach.
本研究旨在评估楔形切除术（WR）、楔形切除术联合近距离放射治疗（WRB）或立体定向体部放射治疗（SBRT）用于早期非小细胞肺癌的疗效。
回顾性收集1993年至2012年接受WR、WRB或SBRT治疗的患者数据。WRB组中，根据手术评估，切缘接近或阳性的患者使用铯-131（Cs131）。采用Kaplan-Meier生存分析和对数秩检验比较不同组之间的无病生存期/总生存期。使用Cox比例风险回归分析进行多变量分析，以评估年龄、性别和治疗方法对无病生存期的独立影响。
本研究共纳入272例患者（123例行WR，52例行WR+Cs-131，97例行SBRT）。Cs-131用于外科医生认为高风险的WR手术。三组的局部控制（LC）情况相似，WR组为92.2%，WR+Cs-131组为96.2%，SBRT组为95.5%（p = 0.60）。多变量分析显示，虽然女性的LC率较高，但LC和远处转移均与年龄或性别无关（p分别为0.65和0.41）。WR+B组的5年总生存率为100%，WR组为97.7%，SBRT组为89.6%（p = 0.02）。三组的毒性反应相似。
对于不适合肺叶切除术的早期非小细胞肺癌患者，WR、WR+Cs-131或SBRT都是优秀的治疗选择。对于高风险的WR手术，我们倾向于使用铯-131近距离放射治疗。在进行前瞻性随机对照研究以评估早期NSCLC的最佳治疗方法之前，治疗选择应基于多学科团队方法。
